Midazolam causes less sedation in volunteers with red hair

Abstract

P Pu ur rp po os se e: : We studied sedation, cognition, and mood during midazolam infusion in volunteers with red and non-red (blond or brown) hair, to test the hypothesis that patients with red hair may require more drugs to attain desired levels of sedation.M Me et th ho od ds s: : Twenty red and 19 non-red hair subjects were studied in a randomized, placebo-controlled cross-over design. Subjects were studied during placebo and midazolam at 30 ng·mL -1 target effect site concentration. Sedation was assessed using the observer's assessment of alertness/sedation (OAA/S) scale, the drowsiness visual analogue scale (VAS), and the bispectral index; cognition was assessed using the Repeatable Battery for Assessment of Neuropsychological Status; and mood was assessed using the bipolar form of the Profile of Mood States (POMS).R Re es su ul lt ts s: : Red hair volunteers showed significantly higher OAA/S (P < 0.01) and lower drowsiness VAS (P < 0.05) scores compared to non-red hair subjects during midazolam infusion. Visuospatial score was significantly higher in subjects with red compared to nonred hair during placebo and midazolam trials. Delayed memory score was significantly higher during midazolam infusion in subjects with red compared to non-red hair. There were no group differences in POMS during either trials.C Co on nc cl lu us si io on n: : Midazolam appears to cause significantly less sedation and cognitive impairment in red haired subjects. Objectif : Étudier la sédation, la fonction cognitive et l'humeur pendant une perfusion de midazolam chez des volontaires aux cheveux roux et non roux (blonds ou châtains) pour tester l'hypothèse voulant que chez les patients aux cheveux roux, il faut de plus grandes quantités de médicaments pour obtenir les niveaux de sédation désirés. Méthode Conclusion : Le midazolam semble causer moins de sédation et d'altération de la fonction cognitive chez les sujets aux cheveux roux.NECDOTAL descriptions exist that subjects with red hair may faint easily and are difficult to anesthetize. 1 A mail survey of anesthesiologists A has shown that redhaired patients are perceived to have a propensity for drug hypersensitivity, airway difficulties, hemodynamic instability, dysrrhythmias, combativeness and confusion at anesthesia emergence, nausea/vomiting, and bleeding. Our clinical observations suggest that patients with red hair may also require more drugs to attain desired levels of sedation.

Intraoperative awareness risk, anesthetic sensitivity, and anesthetic management for patients with natural red hair: a matched cohort study

“…2,3 In a randomized placebo-controlled crossover trial, midazolam administration produced less sedation and cognitive impairment in red-haired subjects than in control subjects. 2 Red-haired female volunteers showed increased sensitivity to thermal pain and decreased efficacy of the local anesthetic agent, lidocaine.…”

“…2,3 In a randomized placebo-controlled crossover trial, midazolam administration produced less sedation and cognitive impairment in red-haired subjects than in control subjects. 2 Red-haired female volunteers showed increased sensitivity to thermal pain and decreased efficacy of the local anesthetic agent, lidocaine. 3 While these results suggest patients with red hair may recover from anesthesia faster and suffer more severe postoperative pain than those without red hair, a study in surgical patients did not find any difference in the time to recovery after surgery or the severity of postoperative pain.…”

Natural hair color and the incidence of endometriosis

“…The gene associated with "red hair" on chromosome 4 is proximal to a cluster of genes associated with fibrinogen (25), and there has long been anecdotal belief that patients with red hair color exhibit decreased coagulation / increased risk of hemorrhage during surgical procedures (3,5,10). In a recent study comparing nine red-haired women with nine "dark"-haired women (all Caucasian and comparable in height, weight, and age), the red-haired women exhibited a significant decrease in platelet function but no absolute differences in platelet numbers or coagulation factors (4).…”

“…Women with naturally red hair have been hypothesized to have altered coagulation (3)(4)(5) and immune function (6,7). Cross-sectional studies have suggested that the proportion of women with naturally red hair is greater among those with endometriosis compared with the general population (8 -10).…”

Analgesia and sedation in the intensive care unit: an overview of the issues

“…It is important to keep in mind the considerable variability among patients with respect to the most important issues and optimal choices in pharmacologic management, based on such factors as age and organ dysfunction. There is emerging evidence that genetic variability exists for relative susceptibility to opioids [ 37 ] and probably for other important drug classes [ 38 ]. In addition, the patient's condition typically changes over the course of ICU hospitalization, as do the targets for analgesia and sedation.…”